Healthy Nantucket 2020 - Nantucket 2017 Community Health Improvement Plan February 2017 - Nantucket Cottage Hospital
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Healthy Nantucket 2020 Nantucket 2017 Community Health Improvement Plan February 2017
INTRODUCTORY LETTER Dear Community Partner, Healthy Nantucket 2020, the Nantucket 2017 Community Health Improvement Plan, is the result of extensive collaboration among the island’s health and human services agencies, non-profit organizations, the Town of Nantucket’s Department of Health, as well as year-round and seasonal residents of the island. From September 2016 through January 2017, these community stakeholders came together during a series of public forums and meetings to identify Nantucket’s most pressing health needs, prioritize the top issues for the island, and develop goals and strategies to make meaningful change in these areas. During this collaborative and participatory process, dozens of community groups, organizations, and individuals contributed valuable insight and perspectives. The resulting document, Healthy Nantucket 2020, reflects this comprehensive process and the wide range of community stakeholders who offered their expertise and knowledge. This plan does not belong to Nantucket Cottage Hospital or any other single entity, but is rather the community’s plan to address the most important health issues we face. In the weeks, months, and years ahead, we look forward to implementing the strategies identified in this plan, developing innovative and collaborative solutions, and achieving the goals we have set together to improve the health and wellbeing of the Nantucket community. Thank you for joining with your friends, neighbors, and colleagues in contributing toward this important endeavor. Sincerely, Margot Hartmann, MD, PhD President & CEO, Nantucket Cottage Hospital Tucker Holland Housing Consultant, Town of Nantucket Paula Leary Administrator, Nantucket Regional Transit Authority Kevin Marshall Sergeant, Nantucket Police Department Beth Ann Meehan Mortgage Lending Officer, Cape Cod Five Cent Savings Bank Nick Ouellette, DC Chiropractic Physician Jamie Roberts DMD Paul Roberts, DDS Tracy Roberts Family Activities Specialist, Nantucket Community School Alex Rosenberg Site Manager, Nantucket Family Planning Roberto Santamaria Director, Town of Nantucket Health Department Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 2
Table of Contents
INTRODUCTORY LETTER ...........................................................................................................2
EXECUTIVE SUMMARY ..............................................................................................................4
HEALTHY NANTUCKET 2020: NANTUCKET 2017 COMMUNITY HEALTH IMPROVEMENT PLAN ........6
I. BACKGROUND .................................................................................................................6
II. OVERVIEW OF HEALTHY NANTUCKET 2020 .......................................................................6
What Is a Community Health Improvement Plan? ..................................................................................... 6
How To Use The Community Health Improvement Plan ........................................................................... 6
Relationship Between the Community Health Improvement Plan and Other Guiding Documents and
Initiatives ............................................................................................................................................ 7
Methods ...................................................................................................................................................... 7
IV. PROCESS FROM ASSESSMENT TO PLANNING .....................................................................8
V. HEALTHY NANTUCKET 2020 PLAN COMPONENTS ..............................................................8
Development of Data-Based, Community-Identified Health Priorities ....................................................... 8
Priorities Identified for Healthy Nantucket 2020 ....................................................................................... 11
The Plan’s Strategic Framework .............................................................................................................. 11
VI. HEALTHY NANTUCKET 2020 .......................................................................................... 11
Priority Area 1: Behavioral Health ........................................................................................................... 12
Priority Area 2: Women’s and Children’s Health ..................................................................................... 16
Priority Area 3: Access to Health Care.................................................................................................... 19
Priority Area 4: Access to Housing.......................................................................................................... 22
VII. NEXT STEPS ................................................................................................................. 25
VIII. SUSTAINABILITY ............................................................................................................ 25
IX. ACKNOWLEDGEMENTS ................................................................................................... 26
Steering Committee.................................................................................................................................. 26
Prioritization Session Participants ............................................................................................................ 26
Planning Session Participants .................................................................................................................. 28
Consultant Advisors ................................................................................................................................. 28
APPENDIX A: ACRONYMS ...................................................................................................... 29
APPENDIX B: GLOSSARY OF TERMS ....................................................................................... 30
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 3EXECUTIVE SUMMARY
It is critical to understand the specific environmental factors on Nantucket -- where and how we live,
learn, work, and play, and how they in turn influence our health -- in order to implement the best
strategies for community health improvement. To accomplish this goal, Nantucket Cottage Hospital
led a comprehensive community health planning effort to measurably improve the health of
residents on the island. This effort included two major phases:
1. A community health needs assessment (CHNA), conducted by Nantucket Cottage Hospital,
to identify the health related needs and strengths of the island community, and
2. A community health improvement plan (CHIP) to determine major health priorities,
overarching goals, and specific objectives and strategies that can be implemented in a
coordinated way to address these needs.
The CHNA and CHIP are essential frameworks for guiding future services, programs, and policies
for healthcare and public health-serving agencies on the island.
Healthy Nantucket 2020, the 2017 Community Health Improvement Plan, was developed over the
period September, 2016 - December, 2016, using the key findings from the CHNA. The 2015
Nantucket Community Health Needs Assessment is part of Nantucket Cottage Hospital’s ongoing
efforts to assess the health needs of the island community. This effort included focus groups with
the Healthy Community Collaborative and Nantucket Cottage Hospital’s Patient & Family Advisory
Council, as well as a Quality of Life survey that was distributed widely throughout the community.
The 2015 CHNA is accessible at:
http://nantuckethospital.org/wp-content/uploads/2015/08/NCH-2015-CHNA.pdf
To develop a plan for improved community health, and help sustain implementation efforts, the
community health assessment and planning process engaged community partners through different
avenues. These partners included a cross-sector of community members such as health care,
businesses, public safety, schools, emergency response services, holistic healthcare, planning and
development, and transportation, as well as year-round and seasonal residents.
In 2016, Nantucket Cottage Hospital engaged Health Resources in Action (HRiA), a non-profit
public health organization located in Boston, MA, as a consultant partner to provide strategic
guidance and facilitation of the Community Health Improvement Plan process, to review and
provide feedback on draft documents and output, and to develop the resulting plan.
The Steering Committee met at a kick-off meeting on September 13, 2016 to receive an overview of
the planning process, review data outcomes from the CHNA, and review the proposed process and
timeline for engaging community members.
Three Community Forums were held to confirm the CHNA findings and gather additional community
input. On September 20, 2016, Health Resources in Action, Inc. (HRiA) facilitated two community
forums at Nantucket High School. A third community forum, facilitated by Nantucket Cottage
Hospital, was held on October 2, 2016 following the Spanish Mass at St. Mary’s Church.
During the Community Forums, CHNA findings were shared as well as an overview of the
prioritization process for identifying Community Health Improvement Plan priorities. Participants
then took part it a facilitated discussion designed to gather input on the CHNA findings as well as
feedback on health needs that were not captured in the CHNA.
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 4Health Priorities
A group of over 60 key stakeholders gathered on October 6, 2016 to identify the priorities for the
Community Health Improvement Plan. After reviewing the CHNA findings, participants provided
feedback on other health priorities to be considered as part of the prioritization process.
Participants then used a rating tool and with defined criteria and a voting process to identify those
health needs that were both important and feasible for inclusion in the plan.
Three key priorities were selected for planning: Behavioral Health, Access to Healthcare, Women’s
and Children’s Health, and Access to Housing. Language was proposed and agreed upon as a
cross-cutting strategy. Language includes translation services, availability of services and materials
in multiple languages, and the availability of English classes.
Priority Area Goal Statement
Goal 1: Enhance overall wellness for the Nantucket community
Priority 1: Behavioral Health through the implementation of an effective and
collaborative Behavioral Health System.
Priority 2: Women’s and Goal 2: Improve the health, safety, and well-being of all women,
Children’s Health infants, children, and families of the diverse Nantucket
community.
Priority 3: Access to Goal 3: Enhance access to healthcare for the Nantucket
Healthcare community.
Priority 4: Access to Goal 4: Ensure access to safe, stable, affordable, year-round
Housing housing across all income levels.
A group of key stakeholders met for two, half-day planning sessions in November 2016 to develop
the core elements of the Community Health Improvement Plan. In the first planning session,
participants developed and revised goals, and developed draft objectives and indicators. In the
second planning session, participants finalized their draft objectives and indicators, and developed
strategies to meet each objective. The output of these two sessions follows below.
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 5HEALTHY NANTUCKET 2020:
NANTUCKET 2017 COMMUNITY HEALTH IMPROVEMENT PLAN
I. BACKGROUND
It is critical to understand the specific environmental factors on Nantucket -- where and how
we live, learn, work, and play, and how they in turn influence our health -- in order to
implement the best strategies for community health improvement. To accomplish this goal,
Nantucket Cottage Hospital led a comprehensive community health planning effort to
measurably improve the health of residents on the island. This effort included two major
phases:
1. A community health needs assessment (CHNA), conducted by Nantucket Cottage
Hospital, to identify the health related needs and strengths of the island community, and
2. A community health improvement plan (CHIP) to determine major health priorities,
overarching goals, and specific objectives and strategies that can be implemented in a
coordinated way to address these needs.
The CHNA and CHIP are essential frameworks for guiding future services, programs, and
policies for healthcare and public health-serving agencies on the island.
II. OVERVIEW OF HEALTHY NANTUCKET 2020
What Is a Community Health Improvement Plan?
A Community Health Improvement Plan, or CHIP, is a data-driven, collective, action-oriented
strategic plan that outlines the priority health issues for a defined community, and how these
issues will be addressed, including strategies and measures, to ultimately improve the health
of the community. These plans are created through a community-wide, collaborative planning
process that engages partners and organizations to develop, support, and implement the plan.
A Community Health Improvement Plan is intended to serve as a vision for the health of the
community and a unifying framework for organizations to use in leveraging resources,
engaging partners, and identifying their own priorities and strategies for community health
improvement.1
Building upon the key findings and themes identified in the 2016 Community Health Needs
Assessment (CHNA), the Community Health Improvement Plan:
Identifies priority issues for action to improve community health
Outlines an implementation and improvement plan with performance measures for
evaluation
Guides future community decision-making related to community health improvement
How To Use The Community Health Improvement Plan
A Community Health Improvement Plan is designed to be a broad, strategic framework for
community health, and should be modified and adjusted as conditions, resources, and
external environmental factors change. It is developed and written in a way that engages
multiple perspectives so that all community groups and sectors – private and nonprofit
organizations, government agencies, academic institutions, community- and faith-based
organizations, and citizens – can unite to improve the health and quality of life for all people
who live, work, learn, and play on Nantucket. We encourage you to review the priorities and
1
As defined by the Health Resources in Action, Strategic Planning Department, 2012
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 6goals, reflect on the suggested strategies, and consider how you can participate in this effort,
in whole or in part, as either an independent contributor or as a member of a health-focused
agency, organization, or group. Consider: How do your current plans align with the CHIP?
How can your future plans align with the CHIP?
Relationship Between the Community Health Improvement Plan and Other
Guiding Documents and Initiatives
The Community Health Improvement Plan was designed to complement and build upon other
guiding documents, plans, initiatives, and coalitions already in place to improve the public
health on Nantucket. Rather than conflicting with or duplicating the recommendations and
actions of existing frameworks and coalitions, the participants of the planning process
identified potential partners and resources already engaged in these efforts wherever
possible.
Methods
Following the guidelines of the National Association of County and City Health Officials
(NACCHO), the community health improvement process was designed to integrate and
enhance the activities of many organizations’ contributions to community health improvement,
building on current assets, enhancing existing programs and initiatives, and leveraging
resources for greater efficiency and impact. To develop the Community Health Improvement
Plan, Nantucket Cottage Hospital engaged influential leaders in healthcare, academia, mental
health, local government, social services, and other community based organizations.
The overall process, which includes assessment, planning, implementation, and evaluation, is
a continuous cycle of improvement that seeks to show demonstrable improvement on key
health priorities over the course of time. The cyclical nature of the Core Public Health
Functions is illustrated in Figure 1.
The next phase of Healthy Nantucket 2020 will involve broad implementation of the strategies
through an annual action plan developed from the Community Health Improvement Plan, as
well as monitoring and evaluation of the plan’s short-term and long-term outcome indicators.
Figure 1: The Cyclical Nature of the Core Public Health Functions
Source: Centers for Disease Control and Prevention (CDC), Ten Essential Public Health Services
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 7IV. PROCESS FROM ASSESSMENT TO PLANNING
Nantucket Cottage Hospital and key stakeholders developed this Community Health
Improvement Plan over the period September, 2016 - December, 2016 using the key findings
from the CHNA. The 2015 Nantucket Community Health Needs Assessment is part of
Nantucket Cottage Hospital’s ongoing efforts to assess the health needs of the island
community.
The 2015 CHNA is accessible at
http://nantuckethospital.org/wp-content/uploads/2015/08/NCH-2015-CHNA.pdf
The Community Health Improvement Plan utilized a participatory, collaborative approach
guided in part by elements of the Mobilization for Action through Planning and Partnerships
(MAPP) process.2 MAPP, a comprehensive, community-driven planning process for improving
health, is a strategic framework that many community health coalitions across the country
have employed to help direct their planning efforts. MAPP comprises rigorous assessment as
the foundation for planning, and includes the identification of strategic issues and
goal/strategy formulation as prerequisites for action. Since health needs are constantly
changing as a community and its context evolve, the cyclical nature of the MAPP process
allows for the periodic identification of new priorities and the realignment of activities and
resources to address them.
To develop a plan for improved community health, and help sustain implementation efforts,
the community health assessment and planning process engaged community partners
through different avenues. These partners included a cross-sector of community members
such as health care, businesses, public safety, schools, emergency response services,
holistic healthcare, planning and development, and transportation, as well as year-round and
seasonal residents of the island.
In 2016, Nantucket Cottage Hospital engaged Health Resources in Action (HRiA), a non-profit
public health organization located in Boston, MA, as a consultant partner to provide strategic
guidance and facilitation of the planning process, to review and provide feedback on draft
documents and output, and to develop the resulting plan.
V. HEALTHY NANTUCKET 2020 PLAN COMPONENTS
Development of Data-Based, Community-Identified Health Priorities
In 2015, Nantucket Cottage Hospital conducted the Nantucket Community Health Needs
Assessment is part of Nantucket Cottage Hospital’s ongoing efforts to assess the health
needs of the island community. This effort included focus groups with the Healthy Community
Collaborative and Nantucket Cottage Hospital’s Patient & Family Advisory Council, as well as
a Quality of Life survey that was distributed widely throughout the community.
The Steering Committee met at a kick-off meeting on September 13, 2016 to receive an
overview of the planning process, review data outcomes from the CHNA, and review the
proposed process and timeline for engaging community members.
2
Advanced by the National Association of County and City Health Officials (NACCHO), MAPP’s vision is for
communities to achieve improved health and quality of life by mobilizing partnerships and taking strategic
action. Facilitated by public health leaders, this framework helps communities apply strategic thinking to
prioritize public health issues and identify resources to address them. More information on MAPP can be
found at: http://www.naccho.org/topics/infrastructure/mapp/
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 8Three Community Forums were held to confirm the CHNA findings and gather additional
community input. On September 20, 2016, Health Resources in Action, Inc. (HRiA) facilitated
two community forums at Nantucket High School. A third community forum, facilitated by
Nantucket Cottage Hospital, was held on October 2, 2016 following the Spanish Mass at St.
Mary’s Church.
During the Community Forums, CHNA findings were shared as well as an overview of the
prioritization process for identifying Community Health Improvement Plan priorities.
Participants then took part in a facilitated discussion around the CHNA findings using the
following questions:
1. Was there anything presented that was new or surprising to you?
2. Would you consider the issues we discussed today to be the top health issues in this
community? Why or why not?
3. Do you see gaps in health care in Nantucket County? If yes, where?
4. What is one thing that you think could be done to improve the health of your
community?
The following items were the main themes for health priorities that came out of the health
needs assessment:
1. Alcohol Use Disorders (AUDs) and Substance Use Disorders (SUDs)
2. Access to Housing
3. Mental Health Disorders
4. Cancer
5. Access to Health Care
6. Good Schools, Jobs, and Economy
The following additional themes were identified during the community forums:
1. Children/Pediatrics
2. Women
3. Language
4. Elder Care
A group of over 60 key stakeholders gathered on October 6, 2016 to identify the priorities for
the Community Health Improvement Plan. Participants used a rating tool and with defined
criteria and a voting process to identify those health needs that were both important and
feasible for inclusion in the plan. The following priorities and related topic areas were
presented for their consideration:
Need for more doctors
1. Behavioral Health
Alcohol Use Disorders (AUDs) – PCP’s and Specialty Providers
Substance Use Disorders (SUDs) – Eye Health and Oral Health
Mental Health Disorders Cost to go off island for care
Integration, Collaboration, Alternatives
2. Access to Housing
Affordability 6. Women’s and Children’s Health
Availability Pediatrics & Pediatric Specialists
Homelessness Early Childhood and Childcare
Women’s Health/OBGYN
3. Cancer
High incidence rates of certain 7. Language
cancers Availability of translation services
Availability of services and materials in
4. Good Schools, Jobs, and multiple languages
Economy English classes
High unemployment rates
8. Elder Care
5. Access to Health Care
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 9After discussion at the prioritization meeting, participants added several items to the topics
under the proposed priorities and added Tick Borne Diseases as a ninth priority. The group
accepted a proposal that Language be considered a cross-cutting strategy across all identified
priorities of the Community Health Improvement Plan. It was removed from the list of priorities
for consideration.
Participants were presented with a list of criteria to be used to identify the 3-4 priorities for
Healthy Nantucket 2020. An additional column/criteria for SUSTAINABILITY was added at
the Prioritization Meeting, asking participants to consider the extent to which they thought
sustainable change could be achieved for each health issue.
- Burden (magnitude and severity; economic cost; urgency) of the
RELEVANCE problem
How Important Is It? - Community concern
- Focus on equity and accessibility
- Ethical and moral issues
APPROPRIATENESS - Human rights issues
Should the Community of - Legal aspects
Nantucket Do It? - Political and social acceptability
- Public attitudes and values
- Effectiveness
IMPACT - Coverage
What will the Community - Builds on or enhances current work
of Nantucket Get Out of It? - Can move the needle and demonstrate measureable outcomes
- Proven strategies to address multiple wins
- Community capacity
- Technical capacity
FEASIBILITY - Economic capacity
Can the Community of - Political capacity/will
Nantucket do It? - Socio-cultural aspects
- Ethical aspects
- Can identify easy short-term wins
SUSTAINABILITY - Ability to maintain efforts/activities beyond the initial CHIP timeframe
Participants calculated an overall rating for each health issue by adding their five ratings.
Each participant received three dots stickers and were asked to place their dots on the three
key health issues that received the three highest overall Total Ratings on their rating
worksheet. Participants used their personal judgment to break any ties. The results of the dot
voting process are depicted in the table below.
Key Health Issues Number of Votes
1. Behavioral Health 45
2. Access to Housing 23
3. Cancer 5
4. Good Schools, Jobs, and Economy 12
5. Access to Health Care 28
6. Women’s and Children’s Health 23
7. Language
8. Elder Care 5
9. Tick-Borne Diseases (added by participants) 4
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 10Priorities Identified for Healthy Nantucket 2020
1. Behavioral Health
2. Access to Healthcare
3. Women’s and Children’s Health
4. Access to Housing
The Plan’s Strategic Framework
Following the prioritization meeting, key stakeholders met in November for two, half-day
planning sessions facilitated by HRiA consultants to develop the core elements of the
Community Health Improvement Plan. In the first planning session, participants developed
and revised goals, and developed draft objectives and indicators. In the second planning
session, participants finalized their draft objectives and indicators, and developed strategies to
meet each objective.
Working group participants were provided sample evidence-based strategies from a variety of
resources including The Community Guide to Preventive Services, County Health Rankings,
Healthy People 2020, and the National Prevention Strategy. Indicators for each objective
were identified based on data available from the CHNA, using whenever possible, targets
outlined in Healthy People 2020 (HP2020).
HP2020 is the federal government's prevention agenda for building a healthier nation. It is a
statement of national health objectives designed to identify the most significant preventable
threats to health and to establish national goals to reduce these threats.
The draft Community Health Improvement Plan was completed and disseminated to working
group members for electronic review and feedback. This feedback was incorporated into the
final draft of the plan, which will be used to guide annual implementation plans.
VI. HEALTHY NANTUCKET 2020
Real, lasting community change stems from critical assessment of current conditions, an
aspirational framing of the desired future, and a clear evaluation of whether efforts are making
a difference. Outcome indicators tell the story about where a community is in relation to its
vision, as articulated by its related goals, objectives, and strategies. Targets for identified
outcome indicators have been established using baseline data provided in the Community
Health Needs Assessment, wherever possible. Where no data were readily available,
objectives were noted as “Developmental” and a primary strategy will be to collect and
analyze data and determine a baseline for successive annual comparisons.
The following pages outline the Goals, Objectives, Strategies, Outcome Indicators, and
Potential Partners/Resources for the four health priority areas outlined in the Community
Health Improvement Plan. See Appendix B for a glossary of terms used in this plan.
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 11Priority Area 1: Behavioral Health
When quality of life survey respondents were asked to identify the three most important health
problems on Nantucket (e.g., those that have the greatest impact on overall community
health), the leading problems identified were: alcohol and substance use disorders (63.4%);
access to housing (48.2%); mental health disorders (35.3%); and cancers (20.5%).3
Survey respondents cited substance use disorders as the most pressing health problem on
Nantucket. Alcohol and drug use disorders on Nantucket were also key themes discussed in
focus groups. These problems are not new on the island, but there is increased attention and
awareness due to recent opioid overdoses, the growth of alcohol-fueled events on Nantucket.4
Quality of life survey respondents cited mental health disorders (anxiety, depression, etc.) as
the third most important health problem on Nantucket.5 Focus group participants also noted
the issue of mental health on Nantucket and referred to the number of suicides over the past
year among middle-aged men. They also acknowledged the island’s existing clinicians,
providers, and agencies are all over-extended given the extent of the issues and noted the
great need for an inpatient treatment capacity.6
Goal 1: Enhance overall wellness for the Nantucket community through the
implementation of an effective and collaborative Behavioral Health System.
Objectives
1.1: By 2020, decrease suicide attempts by 10% a year.
Outcome Indicators Baseline 2020 Target Data Source
Number of suicide 34 per year < 25 per Nantucket Cottage
attempts/ideations 2015 year Hospital
Number of suicide deaths 0 per year 0 per year County Clerk
2013-2014 Certification
1 per year
2015-2016
Strategies
1.1.1: Educate all employers (e.g., small and large employers, Builder’s Association,
Chamber of Commerce), on Nantucket and implement Employee Assistance
Programs to recognize and refer high risk employees.
1.1.2: Expand education about suicide risk by assessing and enhancing Signs of
Suicide (SOS) program in Nantucket Schools.
1.1.3: Reduce the stigma surrounding suicidal thoughts by implementing an
evidenced-based peer-to-peer program for the reduction of suicide in the
Middle and High School (e.g., incorporate in existing health education or
establish a hired position).
1.1.4: Establish a full-service mobile crisis unit.
1.1.5: Increase the availability to access needed behavioral health services.
3
NCH 2015 Community Health Needs Assessment, page 12
4
NCH 2015 Community Health Needs Assessment, page 15
5
NCH 2015 Community Health Needs Assessment, page 15
6
NCH 2015 Community Health Needs Assessment, page 16
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 121.2 By 2020, decrease the need for emergency evaluation for mental health
and substance use disorders by 10% per year.
Outcome Indicators Baseline 2020 Target Data Source
Number of ED admissions to 233 170 Nantucket Cottage
hospital Hospital (NCH)
Number of mobile crisis TBD TBD
evaluations
Strategies
1.2.1: Increase psycho-education to the community about mental health and
substance use disorders.
1.2.2: Expand outreach to high risk populations.
1.2.3: Expand mental health and substance use disorders screening (e.g., Employee
Assistance Program (EAP), tracks, schools, hospitality).
1.2.4: Develop sober hobbies that are free and accessible (e.g., art, music,
exercise/gym).
1.2.5: Create community campaign to integrate mental health into ACK festivals (e.g.,
film, book).
1.2.6: Hire staff to reduce wait lists for mental health services.
1.2.7: Expand funding for English Language Learner (ELL) providers, outreach, and
screening tools.
1.2.8: Establish a wellness center that houses all levels of care (e.g., Intensive
Outpatient Program (IOP), Crisis Stabilization Unit (CSU)). (see also 1.5.3)
1.2.9: Offer and fund complementary and alternative medicines/therapies (CAM)
(e.g., art, pet, narrative).
1.2.10: Offer unified crisis response services in all languages.
1.3 By 2020, reduce reported/identified overdoses by 10% per year.
Outcome Indicators Baseline 2020 Target Data Source
Number of first responder 11 8 Nantucket Fire
interventions Department & Police
Department
Strategies
1.3.1: Provide info/training to opioid users and bystanders (friends, family, co-users)
on overdose (OD) risk factors including: danger of using alone, use of benzos,
ETH or other drugs at the same time, re-initiation of use after a period of
abstinence (i.e., lower tolerance).
1.3.2: Identify and agree upon a screening tool to be used by those who screen
individuals at risk of overdose.
1.3.3: Utilize screening tool(s) to identify individuals at risk through screening by
emergency department (ED), EMT, hospital staff, primary care physicians
(PCPs), schools.
1.3.4: Distribute information about causes and consequences of OD to victims and
bystanders, especially those refusing transport, via EMT and first responders.
1.3.5: Provide information on how to reduce OD risk for opioid users who are
admitted, using a harm reduction model.
1.3.6: Educate users/bystanders on recognizing signs of OD and appropriate
management strategies – rescue breathing, Narcan, and contacting EMS.
1.3.7: Provide multiple treatment options and support (Medication-Assisted Therapy,
Group Therapy, etc.).
1.3.8: Enhance the Court Diversion Program for adults and children, including
random probation.
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 131.4 Increase awareness of mental health and substance use disorders, and
preventive services for all ages in the most prevalent languages spoken.
Outcome Indicators Baseline 2020 Target Data Source
Number of exposures/programs TBD TBD
Addiction Awareness Workshop 12/year TBD Behavioral Health
(monthly) Task Force
NAMI run 12-week educational 1/year TBD Behavioral Health
course for people with loved ones Task Force
who have a mental illness
Educational community 6/year TBD Behavioral Health
presentations and/or forums Task Force
Educational presentation for all 2/year TBD Behavioral Health
grade level students (mainly Task Force
middle and high school), on
bullying, substance abuse and/or
depression/suicide prevention
Strategies
1.4.1: Provide educational resources, activities and healthy alternatives for
prevention of mental health and substance use disorders beginning with pre-
natal and post-partum care, continuing through all stages of life.
1.4.2: Adopt system wide evidence-based social and emotional learning program for
all students K-12.
1.4.3: Implement holistic health alternative practices for students (i.e., incorporate
creative arts, yoga, mindfulness, as post or in school activities).
1.4.4: Change the community and others’ perception of Nantucket as a “party”
community (e.g., sober, fun activities 1.2.7, Chamber of Commerce, Nantucket
Police Department (NPD), EMT, NCH, schools, nonprofit organizations, Town
of Nantucket, etc. to address it).
1.5 By 2020, reduce barriers to accessing clinical and community
preventative mental health and substance use disorders services,
especially among populations at greatest risk.
Outcome Indicators Baseline 2020 Target Data Source
Wait Time TBD TBD
Usage of services (e.g. number of TBD TBD
visits to MH providers)
Strategies
1.5.1: Research funding/reimbursement and advocacy for clinical services (*psych
NP/LICSW/case manager).
1.5.2: Create navigation hub and global communication to community.
1.5.3: Create central billing services for behavioral health.
1.5.4: Create Wellness Center for integrated behavioral health services: see also
1.2.8)
• Psychiatrist
• Psych Nurse Practitioner (NP)
• Licensed Independent Clinical Social Worker (LICSW)
• Case Manager
• Complementary and Alternative Medicines (CAM)
Barriers: insurance, finances, language, income, education/cultural
differences, number of clinicians, transportation, night/weekend services,
flexible work schedules (work with employers)
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 14Potential Partners and Resources for Behavioral Health
Alliance for Substance Abuse Prevention (ASAP)
Alternative therapists
Artists’ Association of Nantucket
Cape & Island Suicide Prevention Coalition
Fairwinds / Private Practice / any other mental health provider on island
Gosnold Cape Cod
Nantucket Health Department
Large Nantucket employers
MA State / Fellowship Health resources
Mentor Youth Nantucket (MYN)
Nantucket Boys & Girls Club
Nantucket Chamber of Commerce
Nantucket Cottage Hospital
Nantucket Police Department
Nantucket Fire Department
National Alliance of Mental Illness (NAMI)
Primary care [physicians and pharmacies
Public schools, community schools and private schools
Safe Harbor
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 15Priority Area 2: Women’s and Children’s Health
Participants at the community forums raised the issues of access to OBGYN services,
pediatricians, and pediatric specialists. These have been consistent challenges over time and
were highlighted as health priorities that need to be addressed in this plan. Participants also
wanted to raise awareness of the challenges faced by working parents on the island when
there is a shortage in options available for child care. This was noted as a gap along with
continuum of care for people living on the island.
Goal 2: Improve the health, safety, and well-being of all women, infants, children, and
families of the diverse Nantucket community.
Objectives
2.1: By 2020, increase the number of licensed slots for early childhood care
by 75 slots from children birth – pre-kindergarten.
Outcome Indicators Baseline 2020 Target Data Source
Number of licensed slots for early 230 305 Early childhood
childhood care providers
Strategies
2.1.1: Create a central registration to evaluate the number of licensed daycare
positions available
2.1.2: Increase availabilities for infants/toddlers and preschool children within public
schools, community schools and private schools to accommodate parents
working full time.
2.1.3: Educate potential and existing providers on how to apply, obtain and maintain
licensure.
2.1.4: Explore opportunities for collaboration and operational cost-savings through an
early childhood cohort/collaborative.
2.1.5: Advocate to developers of new multi-purpose construction that they consider
space that can be used for early childhood education.
2.1.6: Identify additional opportunities for space within existing buildings.
2.1.7: Identify grant opportunities to support tuition assistance for childcare.
2.2: By 2020, educate the community about existing services and resources
that are available for women’s and children’s healthcare.
Outcome Indicators Baseline 2020 Target Data Source
Number of education/promotional TBD TBD
encounters
Utilization of online app TBD TBD
Participation at education forums TBD TBD
Strategies
2.2.1: Identify education resources and services available on-island.
2.2.2: Partner with Patient & Family Advisory Council (PFAC) to create an Island
Community Partners Support Model for MotherWoman (state funded program).
2.2.3: Educate expectant and new mothers and all women on warning signs and
symptoms of mood disorders.
2.2.4: Explore and utilize traditional and non-traditional avenues for communicating
existing education resources and messaging (e.g., grocery stores, churches,
Boston Pops concert).
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 162.2.5: Identify key residents and resources within specific communities who can help
deliver educational messages.
2.2.6: Identify which websites have and do not have the ability to translate in different
languages and provide funding for integrating translation services where
needed.
2.2.7: Develop an online app in multiple languages that lists existing services and
resources.
2.2.8: Collaborate and create forums with island organizations and island resources
(Nantucket Community School and NCH PediPFAC have this as a priority work
plan) to educate the community.
(See also Objective 3.1 and 4.5)
2.3: By 2020, establish a baseline rate of preventative dental visits for children
under age 2.
Outcome Indicators Baseline 2020 Target Data Source
Baseline rate of preventative TBD TBD Dental providers
dental visits is established
Strategies
2.3.1: Identify providers on island who provide pediatric dental care, as well as
potential providers through state agencies.
2.3.2: Create a dental collaborative of Nantucket to help align best practices among
Dentists and PCPs.
2.4: By 2020, decrease the rate of dental caries for children under age 2 by
x%.*
Outcome Indicators Baseline 2020 Target Data Source
Increase number of preventative TBD TBD Dental providers
dental visits
Strategies
2.4.1: Establish a rate of dental caries for children under age 2.
2.4.2: Provide dental education in appropriate language as part of newborn hospital
discharge and well-child visits.
2.4.3: Include dental access/education in online app (see Objective 2.2.8).
2.4.4: Solicit community organizations (e.g. golf clubs, foundations, etc.) to create a
general fund to help support pediatric dental care.
2.4.5: Advocate for fluoridating public water in the community.
2.4.6: Work with the Nantucket Public Health Department to educate families about
the importance of fluoride supplementation and the importance of preventative
check-ups and cleanings for children.
* Rate will be established following establishment of current rate of dental caries for
children under age 2.
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 172.5: By 2020, increase the number of children entering the educational system
(including private and public) who have had an annual pediatric well visit
by 50%.
Outcome Indicators Baseline 2020 Target Data Source
Number of children who answer TBD TBD School enrollment
“yes” to well visit question when forms
entering the educational system
Strategies
2.5.1: Connect families to pediatric provider options at pre-natal visits with a warm
introduction.
2.5.2: Identify community leaders to build trust with vulnerable and undocumented
populations and connect them with existing services.
2.5.3: Provide education through churches and other organizations on rights and
responsibilities for access to health care.
2.5.4: Communicate existing care and any expansion of services, for example a
Pediatric Walk-In Care, through traditional and non-traditional communication
strategies.
2.5.5: Expand the use of Pediatric Nurse Practitioners.
2.6: By 2020, educate families and children on a balanced and healthy diet.
Outcome Indicators Baseline 2020 Target Data Source
Number of educational sessions TBD TBD
Number of participants at TBD TBD
educational sessions
Strategies
2.6.1: Identify organizations that host a high volume of families and children, and
utilize these as a forum to provide education on a balanced and healthy diet,
obesity, and nutritional impact on dental issues.
2.6.2: Outreach to new immigrant population and share strategies to adapt their diets
with new foods that promote a balanced and healthy diet.
Potential Partners and Resources for Women’s & Children’s Health
Childcare Providers
Churches
Early childhood education
Grocery stores
Pedi PFAC
School Systems
Town of Nantucket
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 18Priority Area 3: Access to Health Care
Nantucket Cottage Hospital is the only medical facility on the island providing primary, urgent,
emergency and surgical care, as well as outpatient services and appointments with medical
and surgical specialists.7 In spite of the wide range of services provided by the hospital, there
is still a shortage of providers overall in the community. Nantucket’s entire population is living
in a federally designated “Heath Professional Shortage Area”, compared to 14.6% of residents
statewide.8
Quality of life survey respondents noted that access to healthcare is the number one factor
that defines a healthy community and just over half of respondents stated that they were
satisfied with the existing health system on Nantucket.9
Community forum participants noted the high cost of having to go off-island for medical care,
particularly for specialists and procedures not available on island.
Goal 3: Enhance access to healthcare for the Nantucket community.
Objectives
3.1: By 2020, compile and coordinate the dissemination of information about
traditional and alternative healthcare services available.
Outcome Indicators Baseline 2020 Target Data Source
Number of hits to the website TBD TBD
Survey of residents to rate the TBD TBD
tool
Number of collaborators TBD TBD
Number of resources distributed TBD TBD
Number of referrals TBD TBD
Strategies
3.1.1: Identify existing medical and healthcare resources and services.
3.1.2: Establish and encourage continued communication between existing entities.
3.1.3: Update information across all existing media and advertising outlets currently
available to include newly identified resources.
3.1.4: Determine the necessity of a new resource data-base.
3.1.5: Disseminate information through multiple avenues (virtual, audio, radio, print).
(See also 2.4 and 4.5)
7
NCH 2015 Community Health Needs Assessment, page 18
8
NCH 2015 Community Health Needs Assessment, page 18
9
NCH 2015 Community Health Needs Assessment, page 19
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 193.2: By 2020, increase awareness of preventative and wellness services as
viable options for care.
Outcome Indicators Baseline 2020 Target Data Source
Utilization of preventative and TBD TBD
wellness services
Strategies
3.2.1: Identify existing/available preventative and wellness services.
3.2.2: Utilize multiple outreach efforts in multiple languages to promote options for
care.
3.2.3: Encourage collaboration and referrals between providers on-island and off-
island.
(See also 3.1)
3.3: By 2020, increase the current number of year-round primary care
physicians (PCPs) by a net gain of two (2) and increase physician
extenders proportionally.
Outcome Indicators Baseline 2020 Target Data Source
Number of primary care 6 8 NCH
physicians
Number of extenders (PAs, NPs) 6 8 NCH
Strategies
3.3.1: Identify barriers and expand methods of recruiting PCPs and extenders to the
island of Nantucket, taking into consideration the national shortage.
3.3.2: Identify criteria and outreach to potential candidates.
3.3.3: Establish methods/standards for retention.
3.3.4: Identify barriers PCP’s face in accepting a position on Island.
3.3.5: Expand programs to “grow our own” healthcare professionals, foster education,
and coordinate scholarship requirements.
3.3.6: Involve community members in the recruitment and retention process.
3.4: By 2020, establish year-round public transportation.
Outcome Indicators Baseline 2020 Target Data Source
Ridership 287,042 496,842 Nantucket Regional
Transit Authority
(NRTA) Farebox
Reports
Strategies
3.4.1: Analyze current available sources for year-round transportation.
3.4.2: Identify funding sources (i.e. Medicaid).
3.4.3: Communicate the services available.
3.4.4: Expand transportation services.
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 203.5: By 2020, increase the awareness of off-island transportation options for
medically-necessary travel.
Outcome Indicators Baseline 2020 Target Data Source
Pre-post survey of residents of 0 10% NRTA/Others
level of awareness
Strategies
3.5.1: Identify existing off-island services.
3.5.2: Communicate/collaborate available services among entities providing
transportation.
3.5.3: Promote available services and how to access them.
3.5.4: Establish financial sustainability to support increased utilization.
Potential Partners and Resources for Access to Healthcare
Chamber of Commerce
Elder services
Four winds
Local advisory councils, association, coalitions
Media (radio, TV, print)
NCH Social Services Department
NRTA
Rotary Club
Saltmarsh Senior Center
Social Media – Facebook, Instagram, Twitter, YouTube, Vimeo, Snapchat, etc.
Town Website
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 21Priority Area 4: Access to Housing
A recent report conducted by Housing Nantucket estimated that new homeownership is
prohibitive to 90% of the island’s households. The lack of price-appropriate housing for people
who work on Nantucket throughout the year is a barrier to a decent quality of life for workers
and their families and an obstacle to hiring qualified people for some specialized positions. As
numerous past studies and reports show, the stock of affordable housing on Nantucket has
been inadequate for a very long time.10 Quality of life survey respondents listed access to
housing as the second most important health problem on Nantucket. In addition, a primary
theme throughout both focus groups was the lack of affordable housing options on the island
for both year-round and seasonal residents.11
The high cost of housing on Nantucket (presents a particular challenge in regards to recruiting
and maintaining adequate levels of an essential services workforce. The median home value
of $929,700 on Nantucket is almost three times the statewide value of $330,100. Moreover,
almost half of homes (43.0%) on Nantucket cost $1 million or more, compared to 3.4%
statewide.12
Goal 4. Ensure access to safe, stable, affordable, year-round housing across all
income levels on Nantucket.
Objectives
4.1: By the end of 2017, advocate for the passage of the Affordable Housing
Bank.
Outcome Indicators Baseline 2020 Target Data Source
Passage of the current proposal by N/A Passed in State Records
the State in Q1 of 2017 Q1 2017
If not passed, advocate that it be N/A
heard again
If no state action, then reauthorized N/A Passed at Town Records
at April 2017 annual town meeting Town
Meeting
Strategies
4.1.1: Lobby the Legislature – (Hire, self-lobby, or internal Nantucket resources?).
• Establish relationships with the two (2) new officials (State Rep and State
Senator).
• Involve leadership of Board of Selectmen.
• Involve builder and realtor community.
• Reauthorize at this year’s (2017) Town Meeting.
• Utilize media (e.g., letters to editor, social media) to raise awareness.
• Seek the support of Massachusetts Governor’s office
4.1.2: Reach out to Martha’s Vineyard towns and organizations to learn about their
housing initiatives and make alliances where appropriate.
4.1.3: Reach out to MA Governor’s office.
4.1.4: Affordable Housing Trust Fund to further define the use of proceeds from the
Housing Bank.
10
NCH 2015 Community Health Needs Assessment, page 9
11
NCH 2015 Community Health Needs Assessment, page 9
12
NCH 2015 Community Health Needs Assessment, page 9
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 224.2: By 2020, identify and adopt zoning strategies to be used to create
incentives for affordable housing on Nantucket.
Outcome Indicators Baseline 2020 Target Data Source
Meetings with planning N/A Get passed Planning Office
department & ideas generated
Zoning articles drafted and N/A Get passed Planning Office
submitted to Town Meeting, if
appropriate
Articles adopted by Town Meeting N/A Get passed Planning Office
Strategies
4.2.1: Research what other communities are trying that is working (focus on other
island and/or resort/vacation communities, and communities with high cost of
housing).
4.2.2: Work with the Nantucket Planning and Economic Development Commission
(NP&EDC) to educate homeowners and developers about existing zoning that
addresses affordable housing and possible proposed changes that may be in
discussion.
4.2.3: Engage realtors to learn their thoughts on zoning.
4.2.4: Conduct a community-wide visioning exercise on what Nantucket might look
like in 2025.
4.2.5: Provide a concept/recommendation for zoning change(s), if appropriate.
4.3: By 2020, expand and promote the existing First Time Home Buyers
Education program to include online and multi-lingual offerings.
Outcome Indicators Baseline 2020 Target Data Source
Offered twice per year in English 2 2 Housing Nantucket
(9-hour program offered on
consecutive Wednesdays)
Number of people who attend or TBD TBD
participate in the educational
programs
Online library Complete
Strategies
4.3.1: Engage translators for multiple languages (volunteers if possible) to translate
English program.
4.3.2: Utilize existing cultural gatherings to promote the First Time Home Buyers
Education program.
4.3.3: Offer childcare for program participants.
4.3.4: Explore the use of translators or whisper translation technologies for all
educational programs.
4.3.5: Explore funding to offer online program at a reduced cost or free of charge.
4.3.6: Engage audio/video/web resources to generate online library in multiple
languages.
4.3.7: Research the preferred delivery method of the education program into
Spanish, Bulgarian, Portuguese, Russian.
4.3.8: Promote via objective 4.5.
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 234.4: By 2020, establish a down payment assistance program for essential
services workforce.
Outcome Indicators Baseline 2020 Target Data Source
Decrease percent down TBD TBD Affordable Housing
payment Trust Fund (AHTF)
Gap financing TBD TBD AHTF
Strategies
4.4.1: Form a task force (include essential service providers, bankers, realtors,
stakeholders, etc.)
4.4.2: Define the criteria for a critical Nantucket workforce program.
4.4.3: Identify funding needed, source, and sustainability plan for long term funding.
4.4.4: Explore the business model (look at other established, successful models).
4.4.5: Define all relevant parameters of the program (pay back, resale, loans, etc.).
4.4.6: Define the application process.
4.4.7: Determine who will administer the program (local bank, non-profit: new or
existing?).
4.4.8: Promote via Objective 4.5.
4.5: By 2020, create and market a public clearing house to raise awareness of
the existing resources that help with housing and housing information for
owners and tenants.
Outcome Indicators Baseline 2020 Target Data Source
AHTF established Established
Clearing House Established
Strategies
4.5.1: Identify what to include in the Clearing House, for example home share
options.
4.5.2: Create a Task Force to reach out to different organizations to gather and
translate information in be included.
4.5.3: Establish an online home for the Clearing House.
4.5.4: Establish a way to keep the info up-to-date.
4.5.5: Include a Housing Booth at Community Health Fairs and other community
events.
4.5.6: Design and develop written materials in multiple languages to promote the
Clearing House.
4.5.7: Distribute written materials around town to convenient locations (need to
determine where).
4.5.8: Utilize media to advertise the Clearing House (e.g., paper, local television,
radio, and social media).
(See also Objective 2.4 and 3.1)
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 24Potential Partners and Resources for Access to Housing
Banks
Churches
Community Preservation Committee (CPC)
Fire
Hospital
Housing Nantucket
Library/Athenaeum
Major Employers
Media
Nantucket Planning and Economic Development Commission (NP&EDC)
Other funding partners
Police
Preservation Groups
Realtors
Schools
Town Departments
VII. NEXT STEPS
The components included in this report represent the strategic framework for a data-driven,
Community Health Improvement Plan. Nantucket Cottage Hospital, Healthy Nantucket 2020
workgroups, partners, stakeholders, and community residents, will continue finalizing,
implementing, and tracking plan progress over the coming year. A progress report will
illustrate performance and will guide subsequent annual implementation planning.
VIII. SUSTAINABILITY
Nantucket Cottage Hospital, Healthy Nantucket 2020 workgroups, partners, stakeholders, and
community residents, will continue the process by refining the specific annual action steps,
assign lead agencies and personnel, and identify resources for each priority area.
NCH will provide executive oversight for the improvement plan, progress, and process,
identifying additional partners that are integral to success of the plan. Community dialogue
sessions and forums will occur in order to engage residents in the implementation where
appropriate, share progress, solicit feedback, and strengthen the plan. Regular
communication through presentations, meetings and via the hospital website to community
members and stakeholders will occur throughout the implementation. New and creative ways
to feasibly engage all parties will be explored at the aforementioned engagement
opportunities.
Healthy Nantucket 2020: Nantucket 2017 Community Health Improvement Plan Page 25You can also read
